The role of alcohol expectancy and drinking refusal self-efficacy beliefs in university student drinking

Development and validation of a Chinese Drinking Expectancies Questionnaire for young adults: A Hong Kong study

INTRODUCTION

Drinking expectancies, the perceived consequences of alcohol consumption, are noted to predict drinking behaviours. However, there is comparatively little research of drinking expectancies in non-Western populations. This study aimed to develop and validate a Chinese Drinking Expectancy Questionnaire (CDEQ-Adult) for Chinese young adults.

METHODS

Face and content validity were first assessed of items generated from literature review and previously conducted focus groups. Exploratory (EFA) and confirmatory factor analyses (CFA) were conducted with split-half samples from a random telephone survey that was conducted on Hong Kong Chinese adults between the ages of 18-34 (n = 675). The instrument's convergent validity and internal reliability were also examined.

RESULTS

The preliminary instrument items showed good content validity (Item Content Validity Index range: 0.8-1.0). The EFA yielded a 31-item, five-factor model consisting of five domains: Negative Consequences, Interpersonal Benefits, Increased Confidence, Health Benefits and Tension/Stress Reduction (variance explained 63.7%). The CFA revealed that the fit indices for the five-factor model using diagonal weighted least squares estimator were χ2 (256, N = 338) = 394.04, p < 0.001, comparative fit index 0.97, SRMR 0.07, RMSEA 0.06 (95% confidence interval 0.06, 0.08), suggesting a good fit of the model. The Cronbach's α coefficients were 0.94, 0.90, 0.86, 0.77 and 0.57, respectively for each of the five domains (n = 675). Significant associations with past month drinking behaviours and future drinking intentions give strong support for convergent validity.

DISCUSSION AND CONCLUSIONS

The CDEQ-Adult is a culturally relevant instrument for assessing drinking expectancies in Chinese young adults for use in future studies.

Drinking Expectancies among Chinese Young Adults: A Qualitative Study from Hong Kong

BACKGROUND

Alcohol expectancies, i.e., the perceived consequences of drinking, have been reported to be important factor in predicting drinking behaviors. However, studies in the Asia region were largely limited to school-based samples. This study aimed to be the first to explore drinking expectancies among urban Chinese young adults.

METHODS

In 2020, eight focus group discussions were conducted with Hong Kong Chinese young adults aged 18-34 (n = 53). The participants included heavy drinkers, light drinkers, and non-drinkers from a wide range of occupations and educational backgrounds. Thematic analysis was conducted to uncover common alcohol expectancies.

RESULTS

Six themes emerged from this study. Four themes that were commonly reported in the literature were the negative consequences of drinking, social bonding, confidence enhancement, and tension reduction. The study also uncovered two culturally relevant alcohol expectancies: health benefits and business drinking expectancies. In contrast to Western samples, Chinese young adults did not report drinking expectancies related to cognitive enhancement or increased sexual interest.

CONCLUSION

Alcohol harm reduction strategies will need to address the positive drinking expectancies uncovered in this study. Future policy discussions in this emerging alcohol market region should consider greater scrutiny of the role of alcohol marketing in the propagation of positive drinking expectancies.

Ethnic/Racial Differences in Alcohol Use: Does Drinking Refusal Self-Efficacy Matter?

Introduction: College students-including those of Hispanic backgrounds-are at risk for hazardous drinking. Research has shown robust group differences between Hispanic and White individuals in alcohol use outcomes. The ability to resist alcohol consumption can be leveraged to reduce hazardous drinking; however, little research has examined Hispanic-White differences and whether drinking refusal self-efficacy accounts for group differences in hazardous drinking. Considering Hispanic individuals make up the largest ethnic/racial minority group in the United States, it is important to identify malleable psychological factors that prevent and reduce drinking problems. Method: Hispanic and White college students at two predominantly White institutions (N = 389; 58.6% women, M_age= 20.22) completed measures assessing drinking refusal self-efficacy, hazardous drinking, and negative drinking consequences. Results: Hispanic students reported lower levels of hazardous drinking, alcohol-related problems, and drinking refusal self-efficacy than White students. Drinking refusal self-efficacy was found to partially explain Hispanic-White differences in the levels of hazardous drinking and drinking-related problems. Specifically, drinking refusal self-efficacy was associated with alcohol use outcomes only among White students and not Hispanic students. Conclusion: The correspondence between drinking refusal self-efficacy and actual behaviors to turn down drinks, ethnic/racial distinctiveness in ratings of self-efficacy and cultural orientations, and situational contexts that surround drinking should be examined in future research.

Development and validation of the Stimulant Refusal Self-Efficacy Questionnaire (SRSEQ) in stimulant users in treatment

BACKGROUND

Self-efficacy is a core component of Social Cognitive Theory. Refusal self-efficacy is an individual's belief in their ability to refuse a substance in specific high-risk situations. Change in refusal self-efficacy is predictive of positive treatment outcomes. Measurement of refusal self-efficacy is critical as it directs coping skills development techniques though existing behavioural treatments. There is no validated measure of stimulant refusal self-efficacy. This study developed and validated the Stimulant Refusal Self-Efficacy Questionnaire (SRSEQ) to measure confidence in the ability to refuse stimulants in specific high-risk situations.

METHOD

Two hundred and seven stimulant-using patients referred for assessment completed the SRSEQ and measures including stimulant dependence severity (Severity of Dependence Scale-Stimulant, SDS-S). Confirmatory Factor Analysis (CFA) using structural equation modelling (SEM) was conducted to test the theoretically-driven three-factor structure of the SRSEQ. Criterion validity was tested with severity of stimulant dependence.

RESULTS

The CFA supported the three-factor structure. Emotional Relief (β = -0.27, p = .008), Opportunistic (β = -0.24, p = .013) and Social Facilitation (β = -0.32, p < .001) refusal self-efficacy were uniquely associated with stimulant dependence severity, explaining 55.1% variance.

CONCLUSIONS

The SRSEQ is psychometrically sound and may be clinically useful to assist with assessment and treatment planning for stimulant use disorder.

Effects of within- and between-person assessments of alcohol expectancies and valuations on use and consequences moderated by sex

BACKGROUND

Alcohol expectancies (AE; beliefs about the likelihood of outcomes) and valuations (beliefs about the desirability of outcomes) may help explain alcohol use by young adults. However, it remains unclear how variability in AE and valuations over time are related to alcohol-related outcomes, and whether these associations are moderated by sex. The current study addressed these gaps in knowledge by examining within-person variability among positive and negative AEs, valuations, and alcohol-related outcomes over a 12-month period.

METHODS

Data were collected from 433 college students (M_age  = 20.06; 59.81% women) who completed surveys at 4 timepoints: at baseline and 3-month, 6-month, and 12-month follow-up.

RESULTS

We found substantial within-person variability in both AE and valuations (intraclass correlation coefficients ranged from 50% to 66%), and differences in variability by sex, with women showing more variability than men. Multilevel models revealed that weekly drinking was significantly higher at timepoints in which participants held relatively greater AE for sociability, sexuality, and risk/aggression, but lower when participants expected greater effects on self-perception. Weekly drinking was also higher when participants reported more favorable valuation of risk/aggression. Participants experienced significantly more negative consequences at timepoints in which they held relatively greater AE for sexuality and self-perception. No AEs were associated with a reduced likelihood of negative consequences. Participants experienced more negative consequences at timepoints in which they reported more favorable valuation of self-perception No valuations were associated with fewer consequences. Several between- and within-person associations were moderated by sex.

CONCLUSIONS

These findings suggest that AE and valuations are dynamic, that young adults' beliefs about the effects of alcohol varied over time, and that both negative and positive AE and valuations may be important correlates of alcohol use and consequences. These findings have implications for interventions designed to challenge expectancies and valuations with the goal of reducing alcohol use and associated consequences.

A comparison of the associations between alexithymia and both non-suicidal self-injury and risky drinking: The roles of explicit outcome expectancies and refusal self-efficacy

Both non-suicidal self-injury (NSSI) and risky drinking are positively associated with alexithymia, a personality trait characterized by difficulties appraising feelings and an externally orientated thinking style. Although researchers have studied the associations between alexithymia and both NSSI and risky drinking, the underlying factors of both associations are rarely compared. Using path analysis, we compared the mediating effects of behaviour-specific outcome expectancies and self-efficacy beliefs on the associations between alexithymia and both NSSI and risky drinking. A sample of 627 university students (76.10% female, Mage = 20.75, SD = 1.88) completed a battery of questionnaires. Alexithymia exhibited indirect effects on NSSI via affect regulation expectancies, pain expectancies, communication expectancies, and low self-efficacy to resist NSSI. Alexithymia exhibited indirect effects on risky drinking via expectations of increased confidence and negative consequences. However, the indirect effects differed depending on the valance of the emotion the individual had difficulties appraising. Our findings indicate that the underlying factors in the associations between alexithymia and both NSSI and risky drinking could differ. Where individuals who have difficulties appraising negative emotions may engage in NSSI to help regulate negative feelings, they may consume alcohol to gain more confidence in expressing their feelings. Clinical implications are discussed.

Alcohol mixed with energy drinks: Expectancies of use and alcohol-related negative consequences among a young adult sample

OBJECTIVE

Energy drinks are a popular mixer with alcohol among college-aged young adults. Few studies to date have examined the relationships between expectancies of alcohol mixed with energy drink (AmED) use, AmED use and AmED-related negative consequences.

METHODS

Eighty college-aged young adults were surveyed regarding their alcohol and AmED use, related negative consequences and AmED expectancies. Associations were assessed using chi-square tests and Cramér's V. A simple mediational model also was used to explore the potential relationships between AmED expectancies, AmED use and AmED-related negative consequences.

RESULTS

AmED use was associated with more types of related negative consequences than heavy alcohol use alone, and where AmED use and heavy alcohol use were mutually associated with a related negative consequence, the strength of association was stronger for AmED use. While several AmED-related negative consequences were associated with AmED expectancies, unwanted sexual contact and getting into a verbal argument were associated with the greatest number of expectancies. The mediational model identified a statistically significant indirect effect of AmED expectancies on AmED-related negative consequences mediated by AmED use.

CONCLUSIONS

The study results contribute to the evidence that AmED use may confer additional risk for related negative consequences beyond heavy alcohol use and suggest that AmED expectancies may have a role in AmED use, which, in turn, is associated with AmED-related negative consequences. AmED expectancies may be targets for intervention to reduce AmED use considering the possible subsequent related negative consequences, especially those involving negative interpersonal experiences.

African American College Students' Drinking Behaviors and Their Relationship to Self-Efficacy and Positive or Negative Expectancies Regarding Alcohol Consumption

College students' alcohol consumption remains a significant concern for colleges and universities. However, most research overwhelmingly utilizes White samples from predominantly White universities, limiting knowledge of African American students' drinking behaviors on historically Black campuses. This study examined alcohol usage among African American college students by investigating relationships between alcohol consumption and positive and negative expectancies as well as self-efficacy. A convenience sample of 282 students was used. The Alcohol Use Disorders Identification Test (AUDIT) measured alcohol consumption and identified individuals whose consumption created hazardous drinking patterns. Alcohol expectancy was measured by the Alcohol Effects Questionnaire (AEQ), and the Spheres of Control Scale measured self-efficacy. Students in this sample tended to believe that alcohol consumption was linked with more negative than positive alcohol expectancy beliefs. Alcohol expectancies, specifically positive expectancies, appeared to play a significant role in predicting alcohol consumption. There was also a positive relationship between positive expectancies and alcohol consumption. Despite these results, our regression model was only able to account for about 20% of the variance (r² = 0.187). These findings are important in developing prevention and intervention programs to address the pervasive and critical social ills and reduce alcohol consumption among African American college students.

Alcohol-related cognitive mechanisms underlying adolescent alcohol use and alcohol problems: Outcome expectancy, self-schema, and self-efficacy

PURPOSE

The objective of this study was to empirically test a theoretical model to determine the cognitive mechanisms that are associated with adolescent alcohol use and alcohol problems. We posited that alcohol outcome expectancies would affect alcohol-refusal self-efficacy through the drinker self-schema. We also posited that alcohol outcome expectancies and the drinker self-schema would affect alcohol use and problems through alcohol-refusal self-efficacy.

METHODS

A survey was administered to 225 adolescents in a public junior high school in Taiwan at two-time points, six months apart. Path analysis was used to determine the mechanisms underlying the alcohol-related cognitive constructs on the alcohol use and alcohol problems separately, controlling for appropriate alcohol-related personal and environmental factors. Indirect effects were estimated using the bootstrapping method.

RESULTS

Higher positive alcohol outcome expectancies and lower negative alcohol outcome expectancies predicted higher drinker self-schema scores. Higher positive alcohol outcome expectancies and drinker self-schema scores predicted lower alcohol-refusal self-efficacy. Lower alcohol-refusal self-efficacy was associated with a history of drinking and alcohol problems in the past six months. Effects of alcohol outcome expectancies on alcohol use and alcohol problems were partially mediated through the drinker self-schema and alcohol-refusal self-efficacy.

CONCLUSIONS

Findings support the proposed theoretical cognitive mechanisms underlying alcohol use and alcohol problems in a sample of Taiwanese adolescents. Given that alcohol-related cognitive constructs are modifiable, the findings also provide a foundation to suggest that interventions to reduce positive alcohol outcome expectations and prevent the formation of a drinker self-schema may facilitate alcohol-refusal self-efficacy and mitigate drinking behaviors in this adolescent population.

A Daily-Level Analysis of Moderators of the Association between Alcohol Expectancies and Alcohol Use among College Student Drinkers

Background: Alcohol expectancies, or the perceived likelihood of experiencing certain effects after consuming alcohol, are associated with college student drinking such that heavier drinkers expect a greater likelihood of positive effects. However, less is known as to whether day-to-day within-person deviations in expectancies are associated with drinking that same day and for whom and when these associations may be strongest. Objectives: The aim of this study was to examine daily-level associations of positive and negative alcohol expectancies with alcohol use, and whether associations differed according to demographic characteristics and additional alcohol-related constructs. Methods: College student drinkers (N = 327, 53.8% female) participated in an intensive longitudinal study that captured daily-level data. Alcohol use and expectancy measures were utilized from a baseline session and at the daily-level using Interactive Voice Response (IVR). Results: Results found that on days when participants reported stronger positive and negative expectancies than their average, they were more likely to drink as well as consume more alcohol when drinking. Moderation analyses revealed that positive expectancies were more positively associated with the likelihood of any drinking for women relative to men, and more positively associated with the quantity of alcohol consumption for younger students, students with lower baseline rates of drinking, and students with greater overall positive alcohol expectancies. Conclusions/Importance: The findings demonstrate that alcohol expectancies fluctuate within-person across days and these fluctuations are meaningful in predicting same-day drinking. Interventions that seek to modify expectancies proximal to drinking events may be considered to reduce college student drinking.

Cognitive and affective empathy in binge drinking adolescents: Does empathy moderate the effect of self-efficacy in resisting peer pressure to drink?

Binge drinking during adolescence is influenced by peer pressure and group norms as risk factors. Conversely, drinking refusal self-efficacy is a protective factor. Thus, adolescents with impaired social skills could be more vulnerable to binge drinking. However, there is still little research on impaired social abilities, such as low empathy, in adolescent binge drinkers. This study aimed to investigate the moderating roles of empathic concerns and perspective-taking in the relationship between self-efficacy in resisting peer pressure to drink (SRPPD) and binge drinking. Participants were 188 Italian adolescents (M_age = 16.93, SD_age = 0.76; age-range: 15-19). Self-report instruments were administered. Binge drinking was evaluated with an open response item according to the clinical definition of symptoms; SRPPD was assessed with an item from the Perceived Self-Efficacy scale; empathic concerns and perspective-taking were measured with the Interpersonal Reactivity Index scale. A moderation regression analysis was run. Results showed that binge drinking is positively predicted by age, and negatively predicted by SRPPD and empathic concerns. Only perspective-taking proved to be a moderator in the relationship between SRPPD and binge drinking. In the presence of low perspective-taking, adolescents with low SRPPD reported more binge drinking than adolescents with high SRPPD. Conversely, for adolescents with high levels of perspective-taking, low SRPPD did not predict binge drinking. Our results shed light on patterns of cognitive and affective empathy in binge drinking adolescents, providing relevant implications for research and prevention for at-risk teenagers.

Validation of the Comprehensive Effects of Alcohol Questionnaire in Older Adults

Background: Alcohol expectancies have been established as an important construct in the prediction of alcohol use among younger adults, but there is little understanding about the perceived expected effects of consuming alcohol in older adults. Beliefs about the expected effects of alcohol may be quite different in older adults compared to young adults, which may also play a different role in their drinking behavior. In older cohorts there may be stigma may be associated with drinking and the nature of drinking experiences may differ to those of younger adults. Existing measures of expectancies are based on the perspectives of younger adults and therefore warrant validation in an older sample. Objectives: The aim of this study is to validate the comprehensive effects of alcohol questionnaire (CEOA) in a sample of older adults, and to investigate the relationships between alcohol expectancies, their evaluations and alcohol use. Methods: A sample of community dwelling older adults (N = 473) completed self-report measures assessing drinking behavior and alcohol expectancies. Exploratory factor analysis, confirmatory factor analysis, and hierarchical multiple regressions were conducted. Results: The final model of the CEOA supported two global dimensions of positive and negative expectancies, and showed excellent goodness-of-fit and internal consistency. Male drinkers were more likely to endorse positive expectancies and favorable evaluations of positive and negative expectancies. Favorable evaluations of positive expectancies were the strongest predictors of drinking frequency and quantity. Conclusions/Importance: The results support for the empirical validity of a two-factor expectancy model consisting of a 10-item negative expectancy factor and a 10-item positive expectancy factor. This more concise version could offer a more acceptable and time efficient measure of expectancies and valuations for older adults. Furthermore, the study provides important findings for the role of evaluations in their prediction of alcohol use.

Independent and relative effects of stress, depressive symptoms, and affect on college students' daily health behaviors

Stress and depressive symptoms are associated with maladaptive health behavior practices such as unhealthy eating, sedentary behavior, insufficient sleep, and substance use. The relative and interactive effects of stress and depressive symptoms on health behavior practices are less well understood. The present study examined these processes in a daily diary study of 127 college students. Results from hierarchical generalized linear models indicated that depressive symptoms, and chronic and daily stress, but not acute stressful life events, were significantly associated with a composite score of daily maladaptive health behavior engagement (depressive symptoms b = .01, SE= .00, p < .01; chronic stress, b = .03, SE= .01, p < .01; daily stress, b = .01, SE= .01, p = .02); unexpectedly, the effect of stress on health behaviors was not moderated by depressive symptoms. Additionally, results demonstrated that the effect of depressive symptoms on health behaviors was mediated by fluctuations in daily negative affect. These results bear implications for intervention during a crucial period in the development of mental and physical health.

Measuring adolescent drinking-refusal self-efficacy: Development and validation of the Drinking Refusal Self-Efficacy Questionnaire-Shortened Adolescent version (DRSEQ-SRA)

BACKGROUND

This study aimed to develop and validate a shortened version of the Drinking Refusal Self-Efficacy Questionnaire-Revised Adolescent version (DRSEQ-RA) using a large sample of adolescents.

METHODS

Secondary school students (N = 2609, M = 14.52 years, SD = 0.94) completed the DRSEQ-RA (consisting of subscales: Social Pressure; Opportunistic; Emotional Relief) and the Alcohol Use Disorders Identification Test (AUDIT). These data were analysed using non-parametric item response theory (NIRT) including Mokken scalability coefficients, and confirmatory factor analysis.

RESULTS

Social Pressure subscale items were better able to distinguish between adolescents with lower or higher levels of drinking refusal self-efficacy, while the Opportunistic and Emotional Relief subscale items were able to distinguish adolescents with low drinking-refusal self-efficacy. The DRSEQ-RA was reduced from 19-items to a 9-item scale and retained the original three-factor structure. The reduced scale was named the Drinking Refusal Self-Efficacy Questionnaire-Shortened Revised Adolescent version (DRSEQ-SRA). The DRSEQ-RA and the DRSEQ-SRA have almost identical psychometric properties. They both demonstrated good fit to the data, each explained 18% of the variance in alcohol consumption, Adj. R² = 0.18, p < .001 respectively. The DRSEQ-RA and the DRSEQ-SRA also have excellent scale and subscale internal reliability (αs = 0.92-0.99).

CONCLUSIONS

The DRSEQ-SRA is a short, 9-item, measure of adolescent drinking-refusal self-efficacy which demonstrates both reliability and validity. A significant advantage is brevity. The DRSEQ-SRA may be a valuable tool for identifying risk of adolescent drinking and prevention/treatment planning in settings where survey administration time is critical.

Alcohol expectancies pre-and post-alcohol use disorder treatment: Clinical implications

BACKGROUND AND AIMS

Modification of elevated positive expectations of alcohol consumption (alcohol outcome expectancies; AOEs) is a key feature of Cognitive Behaviour Therapy (CBT) approaches to Alcohol Use Disorders (AUDs). Despite extensive research supporting the efficacy of CBT for AUD, few studies have examined AOE change. This study aimed to assess AOE change following completion of CBT for AUD and its association with drinking behaviour.

METHOD

One-hundred and seventy-five patients who completed a 12-week CBT program for AUD were administered the Drinking Expectancy Questionnaire (DEQ) at pre-treatment assessment and upon completion of treatment. Abstinence was achieved by 108 (61.7%) of completing patients. For patients who lapsed, the mean proportion of abstinent days was 93%.

RESULTS

DEQ scales assessing expectations of positive alcohol effects on tension reduction, assertiveness, and cognitive enhancement were significantly lower post-treatment (p<0.001). Expectations of negative effects on mood were higher post-treatment (p<0.001). The largest AOE change occurred on the tension reduction scale. Greater percentage of abstinent days over treatment was associated with lower pre-and post-treatment tension reduction expectancy scores (p<0.05). Drinking during treatment was associated with smaller changes in expectations of negative effects of alcohol on mood (p<0.05).

CONCLUSIONS

Individuals who completed CBT treatment for AUD showed significant AOE change. Tension reduction and affective change expectancies may be particularly important for abstinence and useful markers of lapse risk.

A Comparative Study of Factors Associated with Relapse in Alcohol Dependence and Opioid Dependence

BACKGROUND

Alcohol and opiates are among the most addictive substances posing significant public health problems due to the biopsychosocial impact that they have on individuals. Research shows that majority of abstinent alcohol and/or opioid dependence subjects relapse within 1 year. It has also been estimated that 26-36 million people worldwide abuse opiates, with exceptionally high-relapse rates. The purpose of this study was to compare the sociodemographic factors and correlates relapse in alcohol dependence and opioid dependence.

METHODOLOGY

This research uses a cross-sectional comparative study design with a sample size of 60 drawn from a population of clinically diagnosed patients of alcohol dependence (n = 30) or opioid dependence (n = 30) and seeking treatment for relapse. In addition to collecting sociodemographic data, other factors such as craving, affect, self-efficacy, and expressed emotions were measured using standardized instruments including brief substance craving scale, Bradburn affect balance scale, drug avoidance and self-efficacy scale and family emotional involvement, and conflict scale. The data were statistically analyzed.

RESULTS

Disparity in sociodemographic factors was seen in both the groups with opioid group being more likely to be single, unemployed, belonging to lower socioeconomic status, and having a criminal record (P = 0.025). Among factors associated with relapse, the opioid group scored significantly higher on craving, perceived criticism (P = 0.0001), and lower on self-efficacy (P = 0.016). Most common reason cited for relapse in both the groups was desire for positive mood.

CONCLUSION

This study highlights the role of social determinants in drug dependence and relapse. Relapse was found to be a complex multifactorial phenomenon. Despite differences in presentation, somewhat similar relapse mechanisms were seen in both groups.

Not all drinking events are the same: Exploring 21st birthday and typical alcohol expectancies as a risk factor for high-risk drinking and alcohol problems

Alcohol expectancies are a central construct in understanding college student typical alcohol use. However, to our knowledge, there is no research addressing how alcohol expectancies for specific events (i.e. 21st birthday) are different from expectancies regarding typical drinking. We examine the extent to which 21st birthday alcohol expectancies differ from general alcohol expectancies and how 21st birthday expectancies are associated with actual alcohol use and consequences experienced on 21st birthdays, above and beyond expectancies for typical drinking. Participants were college students (N=585; 54% women) who were turning 21 within a week, and intended to drink 4/5 (female/male) drinks on their birthday. All negative expectancies (impairment, risk and aggression, negative self-perception) and positive expectancies (social, liquid courage, sex) except tension reduction were significantly greater for 21st birthday drinking than for typical drinking. While 21st birthday expectancies were not uniquely related to actual birthday drinking, several positive and negative 21st birthday expectancy subscales were associated with 21st birthday drinking-related consequences, even when controlling for typical drinking expectancies. Expectancy challenge interventions aimed specifically at these subscales may be effective at attenuating alcohol-related consequences that result from 21st birthday drinking.

Patterns of Alcohol Consumption in Spanish University Alumni: Nine Years of Follow-Up

The aim of this study was to empirically identify different profiles of Spanish university alumni, based on their alcohol use over 9 years, and to further characterize them. A cohort study was carried out between 2005 and 2015 among university students (Compostela Cohort-Spain; n₂₀₁₅ = 415). Alcohol consumption was measured using the Alcohol Use Disorder Identification Test (AUDIT). A two-stage cluster analysis, based on their AUDIT total scores was carried out separately for males and females. The further characterization of every profile was based on demographic data, age at onset of alcohol use, positive alcohol-related expectancies, tobacco and cannabis use, as well as their answers to some European Addiction Severity Index items. Five different clusters were identified: Low users (29.2%), Moderated users (37.2%), At-risk users (14.2%), Decreasing users (13.2%) and Large users (6.2%) for females, and Low users (34.4%), At-risk users (25.6%), High-risk users (15.6%), Decreasing users (14.4%) and Large users (10.0%) for males. Being a cannabis user or a smoker was positively associated to those more hazardous clusters in both genders. Regarding females, significant differences in the age of onset and high positive expectancies were found. However, there were few significant differences among the groups in relation to their employment status and social relations. The results reveal the existence of different typologies of alcohol users among university alumni, with differences among males and females. Modifying positive expectancies, limiting access to alcohol at a young age, and reducing uses of other substances uses are key to promote healthier alcohol use profiles and to prevent hazardous uses.

Sex differences in the interacting roles of impulsivity and positive alcohol expectancy in problem drinking: A structural brain imaging study

Alcohol expectancy and impulsivity are implicated in alcohol misuse. However, how these two risk factors interact to determine problem drinking and whether men and women differ in these risk processes remain unclear. In 158 social drinkers (86 women) assessed for Alcohol Use Disorder Identification Test (AUDIT), positive alcohol expectancy, and Barratt impulsivity, we examined sex differences in these risk processes. Further, with structural brain imaging, we examined the neural bases underlying the relationship between these risk factors and problem drinking. The results of general linear modeling showed that alcohol expectancy best predicted problem drinking in women, whereas in men as well as in the combined group alcohol expectancy and impulsivity interacted to best predict problem drinking. Alcohol expectancy was associated with decreased gray matter volume (GMV) of the right posterior insula in women and the interaction of alcohol expectancy and impulsivity was associated with decreased GMV of the left thalamus in women and men combined and in men alone, albeit less significantly. These risk factors mediated the correlation between GMV and problem drinking. Conversely, models where GMV resulted from problem drinking were not supported. These new findings reveal distinct psychological factors that dispose men and women to problem drinking. Although mediation analyses did not determine a causal link, GMV reduction in the insula and thalamus may represent neural phenotype of these risk processes rather than the consequence of alcohol consumption in non-dependent social drinkers. The results add to the alcohol imaging literature which has largely focused on dependent individuals and help elucidate alterations in brain structures that may contribute to the transition from social to habitual drinking.

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Alcohol expectancy (AE) and impulsivity are risk factors for problem drinking.

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AE mediates the correlation between right insula GMV and problem drinking in women.

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AE and impulsivity interacts to mediate left thalamus GMV and problem drinking in all.

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Models where changes in GMV as a result of problem drinking are not supported.

The Role of Alcohol Expectancies in Sexual Risk Behaviors Among Adolescents and Young Adults in the Democratic Republic of the Congo

PURPOSE

Considering the increased risk of HIV among alcohol users, we explored the role of individual alcohol expectancies in risk behaviors among youth in the Democratic Republic of the Congo.

METHODS

We surveyed 1,396 adolescents (ages 15-19) and young adults (ages 20-24) on alcohol and sexual behaviors in May, 2010. We assessed expectancies of alcohol use (1) leading to sex or positive sexual experiences; (2) diminishing one's ability to resist unwanted sex; and (3) diminishing one's ability to use or negotiate use of condoms. Adjusted logistic regression models assessed the association between alcohol use and alcohol expectancies with unprotected sex and multiple sex partners (MSP).

RESULTS

Participants reporting alcohol use (36.8%) were more likely to have engaged in unprotected sex and MSP than nondrinkers (adjusted odds ratio [AOR]: 2.87, 95% confidence interval [CI]: 2.29-3.60; AOR: 3.73 95% CI: 2.94-4.72, respectively). Among alcohol users, after adjusting for drinking quantity, moderate expectancies of alcohol leading to positive sexual experiences were significantly associated with MSP among adolescent boys (AOR: 4.20, 95% CI: 1.49-11.86) and girls (AOR: 3.97, 95% CI: 1.36-11.60), whereas high expectancies were significant among young adult men (AOR: 2.70, 95% CI: 1.19-6.10). Among adolescent girls who used alcohol, adjusted odds of unprotected sex were elevated among those with expectancies of diminished ability to refuse unwanted sex (AOR: 5.13, 95% CI: 1.41-16.64) or to negotiate condom use (AOR: 16.22; 2.08-126.8).

CONCLUSIONS

HIV prevention efforts for youth should acknowledge the role of alcohol expectancies in sexual risk behaviors and tailor programs to address different roles of expectancies in males and females.

Alcohol misuse in emerging adulthood: Association of dopamine and serotonin receptor genes with impulsivity-related cognition

Impulsivity predicts alcohol misuse and risk for alcohol use disorder. Cognition mediates much of this association. Genes also account for a large amount of variance in alcohol misuse, with dopamine and serotonin receptor genes of particular interest, because of their role in motivated behavior. The precise psychological mechanisms through which such genes confer risk is unclear. Trait impulsivity conveys risk for alcohol misuse by influencing two distinct domains of cognition: beliefs about the reinforcing effects of alcohol consumption (positive alcohol expectancy) and the perceived ability to resist it (drinking refusal self-efficacy). This study investigated the effect of the dopamine-related polymorphism in the DRD2/ANKK1 gene (rs1800497) and a serotonin-related polymorphism in the HTR2A gene (rs6313) on associations between impulsivity, cognition, and alcohol misuse in 120 emerging adults (18-21years). HTR2A predicted lower positive alcohol expectancy, higher refusal self-efficacy, and lower alcohol misuse. However, neither polymorphism moderated the linkages between impulsivity, cognition, and alcohol misuse. This is the first report of an association between HTR2A and alcohol-related cognition. Theoretically-driven biopsychosocial models have potential to elucidate the specific cognitive mechanisms through which distal risk factors like genes and temperament affect alcohol misuse in emerging adulthood.

"Just one bad high:" considering synthetic cannabinoid outcome expectancies in adolescents

BACKGROUND/OBJECTIVES

Certain medical consequences seem unique to synthetic cannabinoid (SC) and not cannabis use. We report the case of an adolescent, whose drug expectancies appear to minimize the severity of SC-related adverse events.

METHODS/RESULTS

An 18-year-old male presented with altered mental status and seizure, complicated by respiratory failure. He was stabilized and on discharge, despite counseling on the harms of SC usage, the patient planned to resume use, insisting that the hospitalization was "just one bad high".

DISCUSSION/CONCLUSIONS/SCIENTIFIC SIGNIFICANCE

Diminished negative expectancies related to SC use among adolescents may reflect generalizations from cannabis. Effective interventions should counter cannabis-related expectancies of minimal harm. (Am J Addict 2016;XX:1-3).

Not the same old thing: Establishing the unique contribution of drinking identity as a predictor of alcohol consumption and problems over time

Drinking identity-how much individuals view themselves as drinkers-is a promising cognitive factor that predicts problem drinking. Implicit and explicit measures of drinking identity have been developed (the former assesses more reflexive/automatic cognitive processes; the latter more reflective/controlled cognitive processes): each predicts unique variance in alcohol consumption and problems. However, implicit and explicit identity's utility and uniqueness as predictors relative to cognitive factors important for problem drinking screening and intervention has not been evaluated. Thus, the current study evaluated implicit and explicit drinking identity as predictors of consumption and problems over time. Baseline measures of drinking identity, social norms, alcohol expectancies, and drinking motives were evaluated as predictors of consumption and problems (evaluated every 3 months over 2 academic years) in a sample of 506 students (57% female) in their first or second year of college. Results found that baseline identity measures predicted unique variance in consumption and problems over time. Further, when compared to each set of cognitive factors, the identity measures predicted unique variance in consumption and problems over time. Findings were more robust for explicit versus implicit identity and in models that did not control for baseline drinking. Drinking identity appears to be a unique predictor of problem drinking relative to social norms, alcohol expectancies, and drinking motives. Intervention and theory could benefit from including and considering drinking identity. (PsycINFO Database Record

Does low coping efficacy mediate the association between negative life events and incident psychopathology? A prospective-longitudinal community study among adolescents and young adults

AIMS

To prospectively examine whether negative life events (NLE) and low perceived coping efficacy (CE) increase the risk for the onset of various forms of psychopathology and low CE mediates the associations between NLE and incident mental disorders.

METHODS

A representative community sample of adolescents and young adults (N = 3017, aged 14-24 at baseline) was prospectively followed up in up to three assessment waves over 10 years. Anxiety, depressive and substance use disorders were assessed at each wave using the DSM-IV/M-CIDI. NLE and CE were assessed at baseline with the Munich Event List and the Scale for Self-Control and Coping Skills. Associations (odds ratios, OR) of NLE and CE at baseline with incident mental disorders at follow-up were estimated using logistic regressions adjusted for sex and age.

RESULTS

NLE at baseline predicted the onset of any disorder, any anxiety disorder, panic disorder, agoraphobia, generalised anxiety disorder, any depression, major depressive episodes, dysthymia, any substance use disorder, nicotine dependence and abuse/dependence of illicit drugs at follow-up (OR 1.02-1.09 per one NLE more). When adjusting for any other lifetime disorder prior to baseline, merely the associations of NLE with any anxiety disorder, any depression, major depressive episodes, dysthymia and any substance use disorder remained significant (OR 1.02-1.07). Low CE at baseline predicted the onset of any disorder, any anxiety disorder, agoraphobia, generalised anxiety disorder, any depression, major depressive episodes, dysthymia, any substance use disorder, alcohol abuse/dependence, nicotine dependence and abuse/dependence of illicit drugs at follow-up (OR 1.16-1.72 per standard deviation). When adjusting for any other lifetime disorder prior to baseline, only the associations of low CE with any depression, major depressive episodes, dysthymia, any substance use disorder, alcohol abuse/dependence, nicotine dependence and abuse/dependence of illicit drugs remained significant (OR 1.15-1.64). Low CE explained 9.46, 13.39, 12.65 and 17.31% of the associations between NLE and any disorder, any depression, major depressive episodes and dysthymia, respectively. When adjusting for any other lifetime disorder prior to baseline, the reductions in associations for any depression (9.77%) and major depressive episodes (9.40%) remained significant, while the reduction in association for dysthymia was attenuated to non-significance (p-value > 0.05).

CONCLUSIONS

Our findings suggest that NLE and low perceived CE elevate the risk for various incident mental disorders and that low CE partially mediates the association between NLE and incident depression. Subjects with NLE might thus profit from targeted early interventions strengthening CE to prevent the onset of depression.

The road to drink is paved with high intentions: Expectancies, refusal self-efficacy, and intentions among heavy drinking college students

The present study examined the effects of drinking intentions (DI) on alcohol expectancies (AE) and drink refusal self-efficacy (DRSE) in regard to alcohol consumption among heavy drinking undergraduates. Research shows that DRSE buffers against drinking (Young, Hasking, Oei, & Loveday, 2007) and interacts with AE to predict alcohol consumption (Oei & Burrow, 2000). Studies further show that DI is predicted by DRSE (Norman, 2011) and AE (Fleming, Thorson, & Atkin, 2004). However, additional research is needed to understand DI's influence on both DRSE and AE among heavy college drinkers. This research included 344 heavy drinking college students (mean age = 23.06 years, SD = 5.61, 74.71% female) from a large southern university who completed study material as part of a larger intervention. Findings showed that DI, DRSE, and AE interacted with respect to heavy drinking such that DRSE was negatively associated with alcohol consumption, particularly among those low in positive AE and high in negative AE. This relationship was stronger among individuals low in DI relative to those high in DI. DI seems to be an important factor influencing heavy drinking among undergraduate students. Present findings further support DI's associations with heavy drinking, regardless of an individual's DRSE or AE. Implications of this research suggest that it may be beneficial for interventions to target specific aspects of AE, including anxious drinking.

Does drinking refusal self-efficacy mediate the impulsivity-problematic alcohol use relation?

There is consistent evidence that impulsivity-like traits relate to problematic alcohol involvement; however, identifying mechanisms that account for this relation remains an important area of research. Drinking refusal self-efficacy (or a person's ability to resist alcohol; DRSE) has been shown to predict alcohol use among college students and may be a relevant mediator of the impulsivity-alcohol relation. The current study examined the indirect effect of various constructs related to impulsivity (i.e., urgency, sensation seeking, and deficits in conscientiousness) via several facets of DRSE (i.e., social pressure, opportunistic, and emotional relief) on alcohol-related problems among a large sample of college students (N=891). Overall, results indicated that certain DRSE facets were significant mediators of the relation between impulsivity-related constructs and alcohol problems. More specifically, emotional-relief DRSE was a mediator for the respective relations between urgency and deficits in conscientiousness and alcohol problems, whereas social-DRSE was a significant mediator of the respective relations between urgency and sensation seeking with alcohol problems. Results from this study suggest particular types of DRSE are important mediators of the relations between specific impulsivity constructs and alcohol-related problems. These findings support prevention and intervention efforts that seek to enhance drinking refusal self-efficacy skills of college students, particularly those high in certain personality features, in order to reduce alcohol-related problems among this population.

Development and Preliminary Validation of the Drinking Expectancy Sexual Vulnerabilities Questionnaire (DESV-Q): A Purpose-Specific Instrument for Rape-Perception Research

BACKGROUND

Alcohol expectancies likely play a role in people's perceptions of alcohol-involved sexual violence. However, no appropriate measure exists to examine this link comprehensively.

OBJECTIVE

The aim of this research was to develop an alcohol expectancy measure which captures young adults' beliefs about alcohol's role in sexual aggression and victimization.

METHOD

Two cross-sectional samples of young Australian adults (18-25 years) were recruited for scale development (Phase 1) and scale validation (Phase 2). In Phase 1, participants (N = 201; 38.3% males) completed an online survey with an initial pool of alcohol expectancy items stated in terms of three targets (self, men, women) to identify the scale's factor structure and most effective items. A revised alcohol expectancy scale was then administered online to 322 young adults (39.6% males) in Phase 2. To assess the predictive, convergent, and discriminant validity of the scale, participants also completed established measures of personality, social desirability, alcohol use, general and context-specific alcohol expectancies, and impulsiveness.

RESULTS

Principal axis factoring (Phase 1) and confirmatory factor analysis (Phase 2) resulted in a target-equivalent five-factor structure for the final 66-item Drinking Expectancy Sexual Vulnerabilities Questionnaire (DESV-Q). The factors were labeled (1) Sexual Coercion, (2) Sexual Vulnerability, (3) Confidence, (4) Self-Centeredness, and (5) Negative Cognitive and Behavioral Changes. The measure demonstrated effective items, high internal consistency, and satisfactory predictive, convergent, and discriminant validity.

CONCLUSIONS

The DESV-Q is a purpose-specific instrument that could be used in future research to elucidate people's attributions for alcohol-involved sexual aggression and victimization.

Social anxiety and drinking refusal self-efficacy moderate the relationship between drinking game participation and alcohol-related consequences

BACKGROUND

Participation in drinking games is associated with excessive drinking and alcohol risks. Despite the growing literature documenting the ubiquity and consequences of drinking games, limited research has examined the influence of psychosocial factors on the experience of negative consequences as the result of drinking game participation.

OBJECTIVES

The current event-level study examined the relationships among drinking game participation, social anxiety, drinking refusal self-efficacy (DRSE) and alcohol-related consequences in a sample of college students.

METHODS

Participants (n = 976) reported on their most recent drinking occasion in the past month in which they did not preparty.

RESULTS

After controlling for sex, age, and typical drinking, higher levels of social anxiety, lower levels of DRSE, and playing drinking games predicted greater alcohol-related consequences. Moreover, two-way interactions (Social Anxiety × Drinking Games, DRSE × Drinking Games) demonstrated that social anxiety and DRSE each moderated the relationship between drinking game participation and alcohol-related consequences. Participation in drinking games resulted in more alcohol problems for students with high social anxiety, but not low social anxiety. Students with low DRSE experienced high levels of consequences regardless of whether they participated in drinking games; however, drinking game participation was associated with more consequences for students confident in their ability to resist drinking.

CONCLUSION

Findings highlight the important role that social anxiety and DRSE play in drinking game-related risk, and hence provide valuable implications for screening at-risk students and designing targeted harm reduction interventions that address social anxiety and drink refusal in the context of drinking games.

Latent Class Analysis of DSM-5 Alcohol Use Disorder Criteria Among Heavy-Drinking College Students

The DSM-5 has created significant changes in the definition of alcohol use disorders (AUDs). Limited work has considered the impact of these changes in specific populations, such as heavy-drinking college students. Latent class analysis (LCA) is a person-centered approach that divides a population into mutually exclusive and exhaustive latent classes, based on observable indicator variables. The present research was designed to examine whether there were distinct classes of heavy-drinking college students who met DSM-5 criteria for an AUD and whether gender, perceived social norms, use of protective behavioral strategies (PBS), drinking refusal self-efficacy (DRSE), self-perceptions of drinking identity, psychological distress, and membership in a fraternity/sorority would be associated with class membership. Three-hundred and ninety-four college students who met DSM-5 criteria for an AUD were recruited from three different universities. Two distinct classes emerged: Less Severe (86%), the majority of whom endorsed both drinking more than intended and tolerance, as well as met criteria for a mild AUD; and More Severe (14%), the majority of whom endorsed at least half of the DSM-5 AUD criteria and met criteria for a severe AUD. Relative to the Less Severe class, membership in the More Severe class was negatively associated with DRSE and positively associated with self-identification as a drinker. There is a distinct class of heavy-drinking college students with a more severe AUD and for whom intervention content needs to be more focused and tailored. Clinical implications are discussed.

Drinking behavior and drinking refusal self-efficacy in Korean college students

The prevalence of drinking behavior and sex differences were examined. A possible relationship between drinking behavior and drinking refusal self-efficacy (DRSE) also was investigated among a convenience sample of 582 Korean college students (309 men, 273 women). A drinking habit scale (from AUDIT-K) and drinking refusal self-efficacy questionnaire (DRSEQ-R) were administered. Results indicated 74.4% of the students drank alcohol and 80.1% of the students were regular drinkers (> 2 to 4 times per month). There were significant differences in drinking behavior by sex and in the DRSE constructs for current drinking statuses. Drinking behavior was significantly associated with sex and DRSE. The present study offers more information about practical interventions aimed at reasonably controlling the drinking behavior of Korean college students in a university setting. The findings may provide better understanding of Korean students' drinking behavior.

Impulsivity-related cognition in alcohol dependence: Is it moderated by DRD2/ANKK1 gene status and executive dysfunction?

Perceived impaired control over alcohol use is a key cognitive construct in alcohol dependence that has been related prospectively to treatment outcome and may mediate the risk for problem drinking conveyed by impulsivity in non-dependent drinkers. The aim of the current study was to investigate whether perceived impaired control may mediate the association between impulsivity-related measures (derived from the Short-form Eysenck Personality Questionnaire-Revised) and alcohol-dependence severity in alcohol-dependent drinkers. Furthermore, the extent to which this hypothesized relationship was moderated by genetic risk (Taq1A polymorphism in the DRD2/ANKK1 gene cluster) and verbal fluency as an indicator of executive cognitive ability (Controlled Oral Word Association Test) was also examined. A sample of 143 alcohol-dependent inpatients provided an extensive clinical history of their alcohol use, gave 10ml of blood for DNA analysis, and completed self-report measures relating to impulsivity, impaired control and severity of dependence. As hypothesized, perceived impaired control (partially) mediated the association between impulsivity-related measures and alcohol-dependence severity. This relationship was not moderated by the DRD2/ANKK1 polymorphism or verbal fluency. These results suggest that, in alcohol dependence, perceived impaired control is a cognitive mediator of impulsivity-related constructs that may be unaffected by DRD2/ANKK1 and neurocognitive processes underlying the retrieval of verbal information.

Examining alcohol consumption with the theory of planned behaviour: Do health and alcohol knowledge play a role?

We used the theory of planned behaviour (TPB) to investigate factors associated with alcohol consumption among university students, and to examine whether general or alcohol-specific health knowledge acts as a moderator in the relationship between elements of the theory and drinking behaviour. Participants were 258 Australian undergraduate university students (79% female) who completed an online questionnaire, assessing the constructs of interest. The hypothesis that intentions and behaviour would be successfully predicted using the theory was generally supported. Little evidence for the moderating effect of knowledge on the TPB variables was observed, although both general and alcohol-specific health knowledge moderated the relationship between intentions and behaviours. Contrary to expectation, more accurate knowledge strengthened this relationship. Further work is necessary to investigate the role of knowledge in limiting alcohol-related harms.

Social context factors, refusal self-efficacy, and alcohol use among female sex workers in China

Excessive alcohol use is considered as a health-risk behavior that may produce negative health outcomes. Examining predictors of alcohol use in social and individual contexts can advance understanding of why people indulge in alcohol use. Our research on female sex workers (FSWs) examined associations among several social context factors (alcohol use by family members, alcohol use by peers, and client-perpetrated pressure or violence), refusal self-efficacy, and alcohol use. Seven hundred FSWs were recruited from two cities in southern China. Structural equation modeling (SEM) was used to analyze the direct effects of alcohol use by family members, alcohol use by peers, and client-perpetrated pressure or violence on FSWs' alcohol use. In addition, the mediation effects of refusal self-efficacy were also examined in the SEM model. Results showed that alcohol use by family members and alcohol use by peers significantly predicted FSWs' alcohol use; the prediction effect of alcohol use by peers on FSWs' alcohol use was stronger than that of alcohol use by family members; client-perpetrated pressure or violence directly predicted FSWs' alcohol use and indirectly influenced FSWs' alcohol use through refusal self-efficacy; refusal self-efficacy directly predicted FSWs' alcohol use. Administrators of effective intervention programs focused on alcohol use in China should adopt a multilevel approach to reduce negative social influences, particularly the influence from peer and sex work establishments on FSWs' alcohol use. Meanwhile, training to improve refusal self-efficacy should also be included in the intervention programs to reduce FSWs' alcohol use.

Protective behavioral strategies, alcohol expectancies, and drinking motives in a model of college student drinking

An extensive body of research asserts alcohol expectancies, or beliefs regarding the effects of alcohol, as an important influence on drinking. However, the extent to which expectancies are related to drinking motives and protective behavioral strategies (PBS) has yet to be examined. Existing alcohol mediational models suggest associations between expectancies and drinking motives as well as positive drinking motives and PBS use. Thus, it is possible that drinking motives and PBS use act as intervening factors in the relationship between expectancies and alcohol outcomes. Consequently, the cross-sectional study presented here aimed to test the indirect effect of expectancies (i.e., social facilitation) on alcohol outcomes through drinking motives and PBS use. Participants were 520 (358 female) college student drinkers with a mean age of 20.80 (SD = 4.61) years. Students completed measures of expectancies, drinking motives, PBS use, alcohol use, and alcohol-related problems. Results from structural equation modeling indicated that drinking motives and PBS mediated the relationship between social expectancies and alcohol use. In particular, expectancies were associated with greater positive drinking motives, drinking motives were associated with less PBS use, and PBS was associated with less alcohol use and fewer alcohol-related problems. Given the key role of PBS in explaining drinking outcomes in our model, active efforts to incorporate PBS in alcohol interventions may be particularly beneficial for college students. Further, our findings support the consideration of PBS use as a part of the motivational model of alcohol use in future work.

The effect of the 'What Do You Drink' web-based brief alcohol intervention on self-efficacy to better understand changes in alcohol use over time: randomized controlled trial using ecological momentary assessment

BACKGROUND

To examine whether (1) the 'What Do You Drink' (WDYD) intervention resulted in drinking refusal self-efficacy (DRSE) changes directly after the intervention, and if so, whether these changes sustained at six-months follow-up and (2) DRSE was related to alcohol use over time, and if so, whether the strength of these relationships differed across conditions. Insight herein can help explain the sustained preventive effects of the WDYD intervention on alcohol use, as reported previously.

METHODS

Alcohol use and DRSE data were collected from 907 participants (60.3% male; M=20.8 (SD=1.7) in a two-arm parallel group randomized controlled trial applying ecological momentary assessment with 30 time-points. Participants were randomized to the experimental (n=456: WDYD intervention) or control condition (n=451: no intervention).

RESULTS

Latent Growth Curve (LGC) analyses that modeled individual change in DRSE over time by condition revealed that participants in the experimental condition experienced a higher social pressure DRSE compared to participants in the control condition at six-months follow-up. Moreover, LGC analyses with time-varying covariates revealed that DRSE was negatively related to weekly alcohol consumption and social pressure DRSE to frequency of binge drinking. The WDYD intervention did not affect the strength of these relationships.

CONCLUSIONS

The WDYD intervention increased the level of social pressure DRSE directly after the intervention that sustained at six-months follow-up. This change is likely to be responsible for the sustained preventive effects of the WDYD intervention on alcohol use, as reported previously.

Alcohol use among Chinese men who have sex with men: an epidemiological survey and meta-analysis

The HIV/AIDS epidemic among Chinese men who have sex with men (MSM) has become a significant public health concern. Knowledge of alcohol consumption in this population is limited. In this study, 1,155 Chinese MSM were surveyed to assess alcohol use and its correlates. A meta-analysis was also performed to aggregate pooled prevalence of current alcohol use. MSM who were unmarried (aOR: 1.87; 95% CI: 1.29-2.71) or unemployed/retired (aOR: 2.77; 95% CI: 1.73-4.45) were more likely to drink alcohol more than once per week. MSM who consumed alcohol more than once per week were more likely to use drug (P < 0.01), have sex with women (P < 0.01), have unprotected insertive (P = 0.04) or receptive (P = 0.03) anal sex with men, have more than 10 lifetime male sex partners (P < 0.01), predominantly practice insertive anal sex (P < 0.01), and trade sex for money (P < 0.01). Pooled overall alcohol use prevalence was 32%. Pooled prevalence for MSM who drank alcohol more than once per week and who drank alcohol before sex with male partners was 23%. Our findings provide the basis for further exploring the alcohol-HIV association and developing risk reduction interventions.

I think I can't: drink refusal self-efficacy as a mediator of the relationship between self-reported drinking identity and alcohol use

This study examined the relationship between self-reported drinking identity (SRDI), defined as how closely individuals believe drinking is a crucial aspect of their identity (Conner, Warren, Close, & Sparks, 1999), and alcohol use by considering drink-refusal self-efficacy (DRSE) as a potential mediator. Based on previous findings, we expected that SRDI would be negatively associated with DRSE and positively associated with drinking, and that DRSE would be negatively linked with drinking. Further, we expected that DRSE would mediate the association between SRDI and drinking. Participants included 1069 undergraduate students (M age=22.93years, SD=6.29, 76.25% female) from a large southern university who completed computer-based study materials. Gender was associated with SRDI, each of the DRSE subscales, and drinking, indicating that males report greater SRDI, lower DRSE, and increased alcohol consumption. Consistent with expectations, SRDI was negatively linked with DRSE and positively linked with drinking. DRSE subscales were negatively associated with drinking. Further, four measurement models for latent variables were tested for SRDI and each of the three DRSE subscales. Results showed that the emotional relief and social subscales of DRSE mediated the association between SRDI and drinking, however this mediating relationship did not emerge for the opportunistic subscale. Implications of these results are discussed.